An Overview of Graves' Ophthalmopathy

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Graves' disease is a thyroid disorder that can have a profound effect on the eyes. Some people with Graves' disease can develop a condition known as Graves' ophthalmopathy, or thyroid eye disease. In Graves' ophthalmopathy, inflammation can affect muscles and other tissues around the eyes.


How the Thyroid Gland Works


If you develop Graves' ophthalmopathy, inflammation and other immune system events can affect the muscles and other tissues around your eyes. Known as exophthalmos, or proptosis, bulging of the eyeballs is a distinguishing symptom of Graves' disease. Exophthalmos often causes the eyes to feel achy, dry and irritated, as the eyelids become unable to perform their duty of sheltering the eyes from injury. Signs and symptoms of Graves' ophthalmopathy include the following:

  • Bulging of the eyes (exophthalmos)
  • Seeing the whites of the eyes all around the pupil
  • Pressure or pain in the eyes
  • Gritty sensation in the eyes
  • Puffy eyelids
  • Red, burning eyes
  • Light sensitivity
  • Double vision (diplopia)
  • Reduced vision
symptoms of graves' ophthalmopathy
Illustration by Cindy Chung, Verywell


Graves' ophthalmopathy occurs in about 30% of people with Graves' disease of the thyroid. In most cases, the immune system attacks the muscles and other ocular tissues of the eye. Inflammation causes swelling and scarring. The cornea may be damaged by the bulging forward of the eyes. Inflamed or scarred muscles that hold the optic nerve in place may also become damaged, resulting in vision loss if left untreated.


If you feel that you are developing signs of eye problems associated with Graves' disease, you will need to have a complete eye exam with an ophthalmologist. Graves' disease sometimes causes inflammation and swelling in the soft tissues and muscles that surround the eyes, often causing the eyeballs to bulge or protrude from their sockets. Doctors will complete a physical exam by looking at the eyes for signs of irritation or signs of the eyes protruding. They will also examine the thyroid gland to see if it is enlarged.


Most of the symptoms of Graves' ophthalmopathy can be treated successfully. Because the eyes may be protruding, the eyelids may not close all the way during sleep or normal blinking, causing irritation. To minimize eye irritation, artificial tears may be used several times per day and ointments may be applied at night to prevent the eyes from drying out. Steroids, such as prednisone, may be given to reduce swelling behind the eyes.

If the eyes are protruding to a great degree, a surgeon may perform orbital decompression surgery. This procedure involves removing the thin bones that make up the orbit of the eye so that the eyes may move back to a more normal position. This is also important because the pressure inside the eye can increase if a considerable amount of pressure builds up around the eye, raising the risk of developing glaucoma. Eye muscle surgery may be performed if needed, and eyeglass prisms may be prescribed if the eye muscles are so swollen that the eyes can no longer be aligned properly.

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Article Sources
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  2. Bahn RS. Graves' ophthalmopathy. N Engl J Med. 2010;362(8):726-38. doi:10.1056/NEJMra0905750

  3. Bausch & Lomb Incorporated. Graves’ disease (graves’ ophthalmopathy)

  4. Griepentrog GJ, Garrity JA. Update on the medical treatment of Graves' ophthalmopathy. Int J Gen Med. 2009;2:263-9. doi:10.2147/ijgm.s6856

Additional Reading
  • Bartlett JD, Siret J. "Clinical Ocular Pharmacology," Chapter 27: Thyriod-Related Eye Disease, pages 699-724. Butterworth-Heinemann, 1989.